Opioid Use and COVID-19: The Impact of Relaxation of Methadone Take-Home Dosing Guidelines on Use of Illicit Opioids

Objectives: The US Substance Abuse and Mental Health Services Administration (SAMHSA) authored an exemption to its existing regulation of methadone maintenance therapy after the onset of the COVID-19 pandemic. This allowed for an increase in methadone take-home doses permitted for the treatment of opioid use disorder beginning in March 2020. We assessed the impact of this exemption on opioid use.Methods: A cross-sectional pre/post study of 187 clients recruited from a methadone clinic who completed a survey and consented to share their urine drug testing data. Use of fentanyl, morphine, hydromorphone, codeine, and heroin was assessed via UDT and receipt of take-home methadone doses. A generalized linear model was used to assess the association between changes in take-home methadone doses and use of illicit opioids as assessed by UDT.Results: Overall, the total number of opioid-positive UDTs increased in the post-COVID-19 time period. However, in the unadjusted descriptive data, when grouped by change in substance use, those clients who experienced a decrease in the use of morphine, codeine, and heroin post-COVID-19 were given significantly more take-home doses than the groups that had no change or an increase in the use of these substances. In the adjusted model, there was no significant relationship between change in opioid use and increased receipt of take-home methadone doses.Conclusions: Even though take-home methadone doses during the COVID-19 SAMHSA exemption time period nearly doubled, this increase in take-homes was not associated with a significant change in use of illicit opioids.